Provider Demographics
NPI:1972578946
Name:SEALS, MARY CHRISTINE (NP)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:CHRISTINE
Last Name:SEALS
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:303 E GURLEY ST # 488
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-3804
Mailing Address - Country:US
Mailing Address - Phone:480-384-0380
Mailing Address - Fax:844-720-7597
Practice Address - Street 1:550 E COTTONWOOD LN STE A
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-2055
Practice Address - Country:US
Practice Address - Phone:520-316-9690
Practice Address - Fax:844-720-7597
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZRN093886363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ11444736OtherCAQH
AZ831554Medicaid
AZ831554Medicaid
AZ11444736OtherCAQH